Why monogamous male couples should stay mindful of HIV

By Rob Stephenson, The Conversation

Updated 7:10 AM ET, Tue December 6, 2016

Chat with us in Facebook Messenger. Find out what's happening in the world as it unfolds.

Photos:Mementos of an epidemic

A special collection at the Stuart A. Rose Manuscript, Archives, and Rare Book Library at Emory University library in Atlanta collected papers and artifacts from the height of the AIDS epidemic. This T-shirt celebrates the city's gay pride parade. It took courage to march in Atlanta's gay pride parades in the 1980s. There were no civil rights protections, but still, attendance tripled, and the community became more visible as it came together to fight stigma and fear that came with the AIDS epidemic. In 1982, the city issued the first official proclamation to honor the festival, but Mayor Andrew Young, already a civil rights icon, would not sign it, according to Atlanta Pride. Two years later, Young showed his support for the community with a proclamation of "Gay and Lesbian Civil Rights Day."

Hide Caption

1 of 12

Photos:Mementos of an epidemic

"The American Music Show" was a quirky, low-budget public access TV program that ran in Atlanta from 1981 to 2005. The weekly show featured interviews and music from the city's underground arts scene. In the wake of the AIDS epidemic that decimated the gay community, campy shows like this were critical to maintaining some fun. The show might be most famous for launching the career of drag/punk performer RuPaul, now the host of "RuPaul's Drag Race." It's "where I really got my start," he told Atlanta's Creative Loafing. "It was college for me."

Hide Caption

2 of 12

Photos:Mementos of an epidemic

Dr. Jesse R. Peel, a retired psychiatrist and long-time AIDS activist in Atlanta, kept his appointment books as a memento of the era. In the 1980s, though, his books took on an additional purpose: chronicling the names of friends he lost to AIDS. There are pages and pages. After so many losses into the 1990s, Peel said, he eventually gave up counting.

Hide Caption

3 of 12

Photos:Mementos of an epidemic

What started out as Peel's joyful travel journal soon took on another purpose as the AIDS epidemic raged around him. Essentially, he took the advice he gave patients dealing with a crisis: Peel wrote to try to make sense of what was happening and to cope with the loss of so many previously healthy young friends. Peel's five volumes give an uncensored glimpse into loss and love, and show how the scope and scale of the disease affected one person deeply.

Hide Caption

4 of 12

Photos:Mementos of an epidemic

Through the epidemic, Peel became an activist helping to help lead AID Atlanta and Positive Impact, a mental health program for people with HIV and their friends. Peel said he liked to throw parties, so he turned them into purposeful fundraisers that helped raise awareness and launch the nonprofits, which still operate today. In the speech shown here, Peel talked about his role as a doctor and described what it was like to reunite a witty young man dying from AIDS with his family. He felt he helped make a positive difference in "how one person leaves this life." Peel, who has now lived with HIV for decades, continues his work in Atlanta as an activist.

Hide Caption

5 of 12

Photos:Mementos of an epidemic

Starting around the mid-1980s, federal and local agencies came out with printed advice to help people better understand the epidemic. The 1986 "Coping with AIDS" pamphlet gave straightforward advice and scientific information to caregivers who worked with a patient population that had little hope. At the time, 70% of people with AIDS died within two years of diagnosis. Others pamphlets explained safe sex, including one that used teddy bear illustrations. The "Be a Buddy" pamphlet recruited volunteers to be paired up with ill people who needed help, whether it was assistance to take medicine or support in their final days.

Hide Caption

6 of 12

Photos:Mementos of an epidemic

This colorful scrapbook from travel agent Willis Bivins captures the joy and sadness of being a part of the LGBT community. It includes photos from New York's first Pride march and Fire Island vacations in the 1960s, hand-printed gay publications and obituaries of friends. Bivins, who moved to Atlanta from New York, didn't like the racism he saw in the LGBT community, so he helped start the group Black and White Men Together in 1981. The group helped pass a city ordinance that banned discriminatory carding at the bars that kept people of color out of those establishments.

Hide Caption

7 of 12

Photos:Mementos of an epidemic

Bivins' scrapbook captures the heartbreaking loss of friends to AIDS, including fellow founders of Black and White Men Together. It also highlights the power that came from supportive artists in the community, such as filmmaker John Waters and performer Divine, who Bivins called "revolutionary artists of my radicalized generation who told our stories in a way that was not always acceptable to the bourgeoisie."

Hide Caption

8 of 12

Photos:Mementos of an epidemic

Thousands had already died by 1986, when the surgeon offered guidance about HIV and AIDS. Surgeon General C. Everett Koop'sreport and the 1988 summary pamphlet that the government mailed to 107 million American homes used "candid but dispassionate language" to review the symptoms and explain how HIV spread. It reassured the public that you couldn't get HIV from a toilet seat or from being in the same room as someone who was infected. It called on schools to provide better sex education and encouraged condom use. Conservatives said it encouraged promiscuity. AIDS activists applauded that it brought the epidemic out in the open and eased some fears. By 1988, there were 82,764 Americans with reported cases of AIDS.

Hide Caption

9 of 12

Photos:Mementos of an epidemic

Playwright Rebecca Ranson wrote more than 30 plays, but her play "Warren," made history as one of the first to deal with the AIDS epidemic. Ranson, who was a lesbian, created the play in 1984 to honor her friend Warren Johnston, an actor who died from AIDS complications that year. Warren had worried that after his short life, no one would remember him. The play, which was staged using some of his possessions as props, explores his life and how his friends and family dealt with his illness. It also explored the role lesbians played in helping gay men. At the time, Ranson said, people told her that watching her play felt like a "religious experience." The back of the Atlanta program lists AIDS service organizations with phone numbers. The Centers for Disease Control and Prevention invited her to present her play at the first International AIDS Conference in Atlanta in 1985.

Hide Caption

10 of 12

Photos:Mementos of an epidemic

The AIDS epidemic moved many people out of the closet and into the streets to fight for greater acceptance. Pins were an easy way to signal support. The pink triangle honored LGBT victims of the Holocaust and was a "reminder of the Holocaust perpetrated by our governments refusing to deal with AIDS," said Cathy Woolard in 1989. Woolard, an Atlanta LGBT organizer, went on to be the Atlanta City Council's first female president. The buttons belonged to Richard Rhodes, a Navy veteran and community organizer who became the first known gay candidate to run for the Georgia House in 1988, and was the first known gay delegate to the Democratic National Convention from Georgia. Every year on his birthday he would get an HIV test. AT 65, he tested HIV-positive. He remains an activist and an advocate for HIV testing.

Hide Caption

11 of 12

Photos:Mementos of an epidemic

In 1987, the inaugural display of the Names Project, otherwise known as the AIDS Memorial Quilt, took up two city blocks and included 1,920 panels memorializing more than 2,000 people who lost their lives to AIDS. It went on display during the 1987 National March on Washington for Lesbian and Gay Rights, which was the largest gathering of its kind. More than 200,000 people marched, demanding equal rights, legal recognition of same-sex relationships, a legal end to discrimination, an increase in funding to fight AIDS and an end to discrimination against people living with HIV and AIDS. Groups from around the country worked for 15 months and held the final organizational meeting in Atlanta. Many Atlanta leaders who helped with that march went on to run nonprofits, arts organizations, media groups and to run for elected office. The Names Project Foundation is now based in Atlanta.

Hide Caption

12 of 12

Story highlights

Men who have sex with men are the only US risk group in which HIV is increasing

Gay men in relationships perceive themselves to be at less risk, research shows

In a relationship there are myriad issues to manage. Who walks the dog? Does his mother like me? Whom are we supporting to win RuPaul's "Drag Race All Stars 2"?

But there is one issue that can often be harder to manage -- how do we as a couple deal with HIV?

Gay men and other men who have sex with men are the only risk group in the U.S. to be experiencing an increase in HIV infections. Over the past four decades of the epidemic, public health messaging about HIV focused mainly on the risks created by unsafe casual sex.

And if you think about it, this makes sense. The average couple has sex 103 times per year, so you literally have more potential exposures to HIV from your main partner than you would in a one-night stand.

Read More

Issues of trust and a desire for intimacy mean that men are often less likely to use condoms with their male partners. Not using a condom can be a way to show you trust your partner more, to feel closer to your partner, or it may just not be convenient to always be using condoms.

Recent research by my team showed that gay men in relationships perceive themselves to be at less risk of HIV and test less frequently for HIV than single men, despite frequent nonuse of condoms with their main partners.

I am fully aware that this may make me sound anti-relationship (something my partner of seven years may take umbrage at). I am not. Relationships are fantastic: I have found the person who doesn't mind me watching "Holiday Baking Championship" while knitting and shouting at the TV, and that is an awesome feeling. But what I am saying is that we need to think about how men in relationships manage HIV.

With marriage equality now legal in the U.S. and the growing visibility of male couples, it is vital that HIV research and programming recognize not only the needs of male couples, but also that couples have the potential to work together on understanding and managing HIV in their relationship.

'Protective bubble' myth

Being in a relationship can make you feel like you are in a protective bubble. For years now we have been warned of the risk of HIV from casual sex, creating this myth that relationships offer a protection from HIV. Early HIV messaging focused on the ABCs of HIV prevention -- abstinence, be faithful and use a condom: the "B" of which almost tells us that being in a relationship is protective.

Beyond messaging, the love blindness that often afflicts us in the early stages of a relationship may prevent us from asking questions about HIV status and from talking to our partners about condom use. As a volunteer HIV counselor and tester, I can't tell you how many times I have had a client tell me "If he was HIV positive he would tell me, he loves me." But this assumes he knows his own status.

It's not that all men who have sex with men don't talk about sex in their relationships. Recent research showed that 90 percent report discussing sexual agreements with their main partner and that 64 percent decide to be monogamous. But given the high prevalence of HIV among gay men in the U.S., there is a high risk that men are entering relationships in which one or both are HIV positive.

The first study, Stronger Together, aims to provide couples in which one is HIV negative and one is HIV positive (known as sero-discordant couples) with the opportunity to come together and make informed decisions that allow them to keep their relationship healthy. This puts the couple at the center of managing their own HIV risk. Guided by a counselor, the couple sets prevention goals and will learn communication skills that allow them to discuss and manage HIV in their relationship.

Join the conversation

See the latest news and share your comments with CNN Health on Facebook and Twitter.

The second, Project Nexus, uses video chat to allow couples to test for HIV together in their own home. Couples are sent home HIV testing kits, and a counselor walks them through the process via a secure video chat system, guiding the couple through the testing process and helping them to create a plan to keep themselves and their relationship healthy.

Central to both of these projects is the concept of helping couples to work together to manage HIV in their relationships. Whether they are both HIV negative, both HIV positive, or if they have different HIV statuses, all couples need a plan that they agree upon and can work together to implement. Our work centers on giving couples those skills.

By teaching couples communication skills, helping them to talk about HIV in their relationships and providing them with access to information and resources that they can use together, these projects allow couples to work together to manage HIV risk.

Rob Stephenson is a professor of nursing at the University of Michigan.